Sacroiliac Joint Special Test Cluster: Difference between revisions
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A study by Levangie et al had developed a TIC for identifying SIJ dysfunction with the following tests: standing flexion test, sitting PSIS palpation, supine long sitting test, and prone knee flexion test. The investigators assessed the diagnostic utility of those tests by comparing findings of patients who complained of LBP with those of patients being treated for other physical impairments not related to the back. They reported that the cluster of these tests exhibited a sensitivity of 0.82 and specificity of 0.88, + LR of 6.83, and - LR of 0.20. It needs to be noted, however, that the reliability of those special tests used for this TIC is poor. Inter-rater reliability kappa values of standing flexion test, sitting PSIS palpation, and prone knee flexion test are reported as follows: 0.08 - 0.32, 0.23 - 0.37, 0.21 - 0.26 respectively (Cleland). Additionally, validity of the results may be questioned due to the reference standard used for this study. | A study by Levangie et al had developed a TIC for identifying SIJ dysfunction with the following tests: standing flexion test, sitting PSIS palpation, supine long sitting test, and prone knee flexion test. The investigators assessed the diagnostic utility of those tests by comparing findings of patients who complained of LBP with those of patients being treated for other physical impairments not related to the back. They reported that the cluster of these tests exhibited a sensitivity of 0.82 and specificity of 0.88, + LR of 6.83, and - LR of 0.20. It needs to be noted, however, that the reliability of those special tests used for this TIC is poor. Inter-rater reliability kappa values of standing flexion test, sitting PSIS palpation, and prone knee flexion test are reported as follows: 0.08 - 0.32, 0.23 - 0.37, 0.21 - 0.26 respectively (Cleland). Additionally, validity of the results may be questioned due to the reference standard used for this study. | ||
More recently, Laslett et al investigated the diagnostic power of pain provocation sacroiliac joint (SIJ) tests individually and in various combinations, in relation to a diagnostic injection. The tests employed in this study were: distraction, right sided thigh thrust, right sided Gaenslen's test, compression and sacral thrust. Those tests were chosen due to its acceptable inter-rater reliability. They found that composites of provocation SIJ tests had significant diagnostic utility. Any 2 of 4 selected tests (distraction, thigh thrust, compression, and sacral thrust) have the best predictive power. When all 6 SIJ provocation tests does not reproduce symptoms, the SIJ pathology can be ruled out. | More recently, Laslett et al investigated the diagnostic power of pain provocation sacroiliac joint (SIJ) tests individually and in various combinations, in relation to a diagnostic injection. The tests employed in this study were: distraction, right sided thigh thrust, right sided Gaenslen's test, compression and sacral thrust. Those tests were chosen due to its acceptable inter-rater reliability. They found that composites of provocation SIJ tests had significant diagnostic utility. Any 2 of 4 selected tests (distraction, thigh thrust, compression, and sacral thrust) have the best predictive power. When all 6 SIJ provocation tests does not reproduce symptoms, the SIJ pathology can be ruled out. | ||
=== Description of Provocation Tests === | === Description of Provocation Tests === | ||
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=== TIC for SIJ Provocation Test === | === TIC for SIJ Provocation Test === | ||
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| 0.16 (0.04, 0.47) | | 0.16 (0.04, 0.47) | ||
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=== Recent Related Research === | |||
Laslett M, Young S, Aprill C, McDonald B. Diagnosing painful sacroiliac joints: a validity study of a McKenzie evaluation and sacroiliac provocation tests. ''Aust J Physiother''. 2003;49:89-97 | |||
Flynn T, Fritz J, Whitman J, et al. A clinical prediction rule for classifying patients with low bak pain who demonstrate short-term improvement with spinal manipulation. ''Spine''. 2002;27:2835-2843 | |||
=== References === | |||
Revision as of 12:47, 11 December 2009
Background[edit | edit source]
Test Item Cluster (TIC) is a group of special tests which are developed to facilitate clinical decision making by improving the diagnostic utility.
A study by Levangie et al had developed a TIC for identifying SIJ dysfunction with the following tests: standing flexion test, sitting PSIS palpation, supine long sitting test, and prone knee flexion test. The investigators assessed the diagnostic utility of those tests by comparing findings of patients who complained of LBP with those of patients being treated for other physical impairments not related to the back. They reported that the cluster of these tests exhibited a sensitivity of 0.82 and specificity of 0.88, + LR of 6.83, and - LR of 0.20. It needs to be noted, however, that the reliability of those special tests used for this TIC is poor. Inter-rater reliability kappa values of standing flexion test, sitting PSIS palpation, and prone knee flexion test are reported as follows: 0.08 - 0.32, 0.23 - 0.37, 0.21 - 0.26 respectively (Cleland). Additionally, validity of the results may be questioned due to the reference standard used for this study.
More recently, Laslett et al investigated the diagnostic power of pain provocation sacroiliac joint (SIJ) tests individually and in various combinations, in relation to a diagnostic injection. The tests employed in this study were: distraction, right sided thigh thrust, right sided Gaenslen's test, compression and sacral thrust. Those tests were chosen due to its acceptable inter-rater reliability. They found that composites of provocation SIJ tests had significant diagnostic utility. Any 2 of 4 selected tests (distraction, thigh thrust, compression, and sacral thrust) have the best predictive power. When all 6 SIJ provocation tests does not reproduce symptoms, the SIJ pathology can be ruled out.
Description of Provocation Tests[edit | edit source]
| Tests | Description (Positive Findings) |
| Distraction | Pt supine. Examiner applies posterolateral directed pressure to bilateral ASIS. (+: reproduction of pain) |
| Compression | Pt sidelying. Examiner compresses pelvis with pressure applied over the iliac crest directed at the opposite iliac crest. (+: reproduction of symptoms) |
| Thigh Thrust | Pt supine. Examiner place hip in 90 deg flexion and adduction. Examiner then applies posteriorly directed force through the femur at varying angles of abduction/adduction. (+: reproduction of buttock pain) |
| Gaenslen's | Pt supine with both legs extended. The test leg is passively brought into full knee flexion, while the opposite hip remains in extension. Overpressure is then applied to the flexed extremity. (+: reproduction of pain) |
| Sacral Thrust | Pt prone. Examiner delivers an anteriorly directed thrust over the sacrum. (+: reproduction of pain) |
Diagnostic Value of Individual SIJ Provocation Tests[edit | edit source]
| Distraction | Compression | Thigh Thrust | Gaenslen's (R) | Gaenslen's (L) | Sacral Thrust | |
| Sensitivity | 0.60 | 0.69 | 0.88 | 0.53 | 0.50 | 0.63 |
| Specificity | 0.81 | 0.69 | 0.69 | 0.71 | 0.77 | 0.75 |
| + LR | 3.20 | 2.20 | 2.80 | 1.84 | 2.21 | 2.50 |
| - LR | 0.49 | 0.46 | 0.18 | 0.66 | 0.65 | 0.50 |
TIC for SIJ Provocation Test [edit | edit source]
Laslett et al reported that the Gaenslen's test did not contribute positively when tests were combined and may be omitted from the diagnostic process without compromising diagnostic confidence. The optimal rule was to perform the distraction, compression, thigh thrust and sacral thrust tests but stopping when there are 2 positives. The diagnostic value of 2 positive tests of the 4 selected test was as follows:
| Values (95% CI) | |
| Sensitivity | 0.88 (0.64, 0.97) |
| Specificity | 0.78 (0.61, 0.89) |
| + LR | 4.00 (2.13, 8.08) |
| - LR | 0.16 (0.04, 0.47) |
Recent Related Research[edit | edit source]
Laslett M, Young S, Aprill C, McDonald B. Diagnosing painful sacroiliac joints: a validity study of a McKenzie evaluation and sacroiliac provocation tests. Aust J Physiother. 2003;49:89-97
Flynn T, Fritz J, Whitman J, et al. A clinical prediction rule for classifying patients with low bak pain who demonstrate short-term improvement with spinal manipulation. Spine. 2002;27:2835-2843
